Diabetic Ketoacidosis

Question 1

Why does development of a new comorbidity potentially trigger diabetic patients to develop diabetic ketoacidosis?

Answer 1

(Comorbidities can lead to worsening of insulin resistance and dysregulation of previously regulated diabetes mellitus = DKA)

Question 2

What type of insulin is used in emergency management of a diabetic crisis?

Answer 2

(Regular insulin → super short acting, not used for maintenance therapy)

Question 3

Sometimes intermediate or long-acting types of insulin can be used to aid in treatment of DKA, you just have to make sure what is true about your patient?

Answer 3

(They are well hydrated, intermediate/long acting insulin are subq injections and if the patient is dehydrated, it’ll take forever for the subq injection to go anywhere; also can be used with top offs of regular insulin to convert DKA to DM)

Question 4

What is the mEq/kg/hr starting dose for supplementing potassium?

Answer 4

(0.2 mEq/kg/hr)

Question 5

When should insulin therapy begin in a case of DKA?

Answer 5

(As soon as the animal is stable (rehydrated, not shocky), ideally that would be within 1-4 hours)

Question 6

You have been treating a DKA patient with a 0.2 units/kg/hr CRI of regular insulin for the past 4 hours (you started at 0.1, BG had only dropped from 546 to 520 so you upped the dose) and their BG is now 65, what do you want to do next?

Answer 6

(Check blood gas and ketones to confirm still DKA (if not that’s a whole diff story) then add dextrose to fluids and see if they will eat)